Provider Demographics
NPI:1033189808
Name:WERNICK, GARY MERLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MERLE
Last Name:WERNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10408 INDUSTRIAL CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4548
Mailing Address - Country:US
Mailing Address - Phone:909-796-7803
Mailing Address - Fax:909-255-7291
Practice Address - Street 1:10408 INDUSTRIAL CIR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4548
Practice Address - Country:US
Practice Address - Phone:909-796-7803
Practice Address - Fax:909-255-7291
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35936207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G359360Medicaid
CA00G359360Medicare PIN
CA00G359360Medicaid
CAA46524Medicare UPIN